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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002333
Report Date: 04/22/2026
Date Signed: 04/22/2026 03:28:10 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/17/2026 and conducted by Evaluator Sarah Benson
COMPLAINT CONTROL NUMBER: 59-AS-20260217123617
FACILITY NAME:PLATINUM HOMEFACILITY NUMBER:
455002333
ADMINISTRATOR:OLSON, CAMERONFACILITY TYPE:
735
ADDRESS:7279 PLATINUM WAYTELEPHONE:
(530) 247-0852
CITY:REDDINGSTATE: CAZIP CODE:
96001
CAPACITY:3CENSUS: 3DATE:
04/22/2026
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Administrator Sian EubankTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Staff did not ensure adequate supervision resulting in an altercation.
INVESTIGATION FINDINGS:
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On April 22 2026, Sarah Benson, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 02-17-26. LPA Benson met with Administrator Sian Eubank and explained the purpose of the visit.

During the interview process, five staff persons, two residents and a witnesses were interviewed. The following documents were received and reviewed: staff list with telephone numbers and work schedule, staff training, client admission agreement, IPP, plan of care and incident reports.

Continued on LIC9099C & LIC9099D

Substantiated
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 59-AS-20260217123617
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: PLATINUM HOME
FACILITY NUMBER: 455002333
VISIT DATE: 04/22/2026
NARRATIVE
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During interviews, it was reported that two staff members were fighting in the back yard of the facility. It was reported during the fight that a section of the wood fence facing southwest was broken and knocked to the ground. It was reported that the fence was picked up off the ground and put back in place. It was reported that R1 witnessed the altercation.
During staff interviews It was reported two staff members were just messing around, S3 stated when S4 was getting out of the headlock hold, S4 fell against the fence and it broke. S3 stated one of the clients may have witnessed the altercation. It was reported that R1 did witness the altercation. It was reported that the altercation was recorded on a staffs' phone.

Record review revealed an incident report dated February 15, 2026 at 8:00 p.m. stated that a client was outside smoking, lost his balance then fell against the fence with his shoulder, breaking a fence board.

While reviewing client’s Individual Program Plan (IPP) it was noted that it is important that R1 has constant supervision due to physical aggression. It was reported during the altercation (physical aggression) two staff members were in an altercation and the other staff member was recording it, staff were not supervising R1.

Based on investigation observations, record review(s) and interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22), is cited on the attached LIC 9099D. Appeal rights were explained and provided to the facility representative listed above and exit interview conducted. If any of the cited deficiencies are not corrected by the noted due date, civil penalties may be assessed.


Continued on LIC9099D
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 59-AS-20260217123617
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PLATINUM HOME
FACILITY NUMBER: 455002333
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/22/2026
Section Cited
CCR
85078(a)(1)
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Responsibility for Providing Care and Supervision

(a) In addition to Section 80078, the following shall apply:

(1) The licensee shall provide those services identified in the client's needs and services plan as necessary to meet the client's needs.
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Administrator will conduct a staff training concerning supervision and meeting the needs of clients.
Administrator will notify LPA when the training is complete.
Administrator completed discplinary action with staff involved.
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This requirement is not met as evidenced by:
Staff were not providing services as necessary to meet the clients needs.
Which poses an immediate health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/17/2026 and conducted by Evaluator Sarah Benson
COMPLAINT CONTROL NUMBER: 59-AS-20260217123617

FACILITY NAME:PLATINUM HOMEFACILITY NUMBER:
455002333
ADMINISTRATOR:OLSON, CAMERONFACILITY TYPE:
735
ADDRESS:7279 PLATINUM WAYTELEPHONE:
(530) 247-0852
CITY:REDDINGSTATE: CAZIP CODE:
96001
CAPACITY:3CENSUS: 3DATE:
04/22/2026
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Administrator Sian EubankTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Staff are not qualified to take care of the residents.
INVESTIGATION FINDINGS:
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During the interview process, the administrator and three staff persons and two residents were interviewed. In addition, documents obtained included staff list with telephone numbers and work schedule, staff training, and incident reports.

During the investigation interviews were performed and files were reviewed.
It was discovered that all staff have training required to meet the Licensing Adult Care Facility regulations.

Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the above findings are Unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4